— '_^_ 


BRO 

An  Inaugural  Dissertation  on  the 

Use  of  Digitalis  Purpurea 


Nd  <*> 


ZtJLlUAA,  »  + 


MM 


Columbia  <Untoer$iQ> 

College  of  ^Bfjpsfictansf  anb  burgeons! 
library 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/inauguraldissertOObrow 


AN 

INAUGURAL  DISSERTATION 

ON   THE    USE    OF 

DIGITALIS  PURPUREA, 


PURPLE    FOXGLOVE, 

IN  THE  CURE  OF  DISEASES. 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION  OF  THE 

FACULTY  OF  PHYSIC 

UNDER    THE    AUTHORITY    OF    THE 

TRUSTEES  OF  COLUMBIA  COLLEGE, 

IN  THE 

STATE  OF  NEW-YORK; 
The  Right  Rev.  BENJAMIN  MOORE,  D.  D.  President; 

FOR  THE  DEGREE  OF 

DOCTOR  OF  PHYSIC, 

ON  THE  4th  OF  MAY,  1302. 


By  JACOB  V.  BROWER,  A.M. 

OF  NEW-YORK. 


NEW-YORK: 


Printed  by  T.  &  J.  Sword  s,  Printers  to  the  Faculty  of  Physic 
of  Columbia  College. 


1S02. 


£■£<£ 
>3>f 


AN 


INAUGURAL  DISSERTATION 


ON 


DIGITALIS  PURPUREA. 


Of  the  Digitalis  Purpurea,  or  Purple  Foxglove. 

1  HE  Digitalis  Purpurea  is  placed  by  Lin^ 
nseus  in  the  class  of  diclynamia,  and  order  of 
angiospermia. 

Botanical  Description. 

The  foxglove  grows  to  the  height  of  four 
or  five  feet,  with  an  erect  and  tapering  stalk. 
The  leaves  are  large,  hairy,  oblong,  and 
pointed.  Their  colour  is  a  dark  dusky  green, 
approximating  to  brown.  The  leaves  exhale 
a  strong  odour,  something  similar  to  tobacco, 
and  have  a  bitter  and  nauseous  taste ;  but  are 
not  so  acrid  and  pungent  as  many  other  veget- 


4 

ables  which  are  administered  in  larger  doses 
with  perfect  safety.  The  nauseous  and  bitter 
qualities  of  the  leaves  can  be  imparted  to 
watery  and  spirituous  menstrua. 

The  floral  leaves  or  bracteae  are  spear- 
shaped,  and  purplish  towards  their  points. 
The  calyx  consists  of  five  eliptical  segments. 
The  flowers  are  monopetalous,  and  of  a  pur- 
ple colour :  they  have  some  resemblance  to 
the  finger  of  a  glove,  whence  the  name  di- 
gitalis, or  foxglove,  originates. 

The  foxglove  grows  in  India,  is  found  in 
many  parts  of  Europe,  and  has  been  culti- 
vated in  this  country.  It  grows  wild  in  woods 
when  left  to  nature,  and  flowers  in  June,  July, 
or  August.  The  digitalis  is  a  biennial  plant, 
which  arrives  at  its  full  growth  and  native 
perfection  only  in  gravelly  soils,  where  there 
is  present  little  or  none  of  the  calcareous 
earth. 

Of  the  growth  and  method  of  curing  the 
Foxglove. 

By  consulting  writers  upon  the  natural  his- 
tory of  this  vegetable,  we  find  that  barren. 


gravelly,  or  sandy  soils,  and  hedges  and  such 
situations  as  are  considerably  elevated,  are 
the  only  places  in  which  it  flourishes  and  ar- 
rives at  its  fullest  maturity.  Botanical  authors 
relate  that  it  delights  in  shade  and  in  deep 
hedge-rows,  and  that  sheltered  ground  is  the 
favourite  situation  of  foxglove. 

This  vegetable  has  lately  been  cultivated 
in  the  suburbs  of  this  city,  and  does  not 
appear  to  degenerate.  It  grows  to  its  usual 
height,  and  puts  on  the  appearance  of  health 
and  vigour. 

Some  plants  arrive  at  the  highest  perfection 
in  their  original  wild  state,  in  woods,  and 
among  shrubs  and  bushes.  But  this  is  not  the 
case  with  all  herbs,  and  probably  it  is  not  the 
case  with  digitalis.  The  foxglove  which  re- 
ceived its  growth  here  has  been  put  to  the 
test  of  experiment.  It  has  been  administered 
in  tincture  and  in  substance.  No  peculiarity 
or  defect  is  observed  in  its  operations  on  the 
human  body.  The  effects  produced  are 
similar  to  those  which  the  imported  foxglove 
usually  produces. 

The  general  employment  of  digitalis  has 
excited  much  attention  with  respect  to  the 


6 

method  of  collecting  and  curing  the  leaves, 
and  the  mode  of  preparing  them  for  use. 

When  the  leaves  of  foxglove  are  gathered 
for  the  purpose  of  preserving  them  a  number 
of  years,  they  should  be  collected  from 
healthy,  vigorous  plants,  growing  on  hills, 
in  an  unmanured  soil,  and  in  situations 
which  are  most  exposed  to  the  rays  of  the  sun. 
Such  plants  as  have  acquired  a  darkish  and 
brownish  colour  are  preferable  to  others. 
After  the  leaves  are  collected  they  are  care- 
fully separated  from  the  stalks,  and  the  latter 
cut  away,  so  as  only  to  leave  room  to  tye  them 
into  small  bunches,  which  are  hung  in  a  warm 
and  airy  apartment.  This  apartment  has  a 
current  of  air  passing  through  it,  and  the 
rays  of  the  sun  excluded. 

The  leaves,  when  dry,  are  partially  pow- 
dered; by  which  operation  the  stalks  and 
fibrous  parts  are  almost  completely  separated. 
The  finer  part  of  the  leaves,  when  sufficiently 
pulverized,  is  bottled  and  closely  corked,  to 
prevent  the  admittance  of  air,  for  future 
use. 

Another  method  of  preserving  this  valuable 
medicine,   not  inferior  to   the  one  already 


mentioned,  is  the  following : — After  dividing 
the  leaves  into  several  pieces,  compress  them 
into  a  tight  and  convenient  box  or  canister. 
Keeping  them  close  in  this  state,  and  in  a  dry 
situation,  they  will  preserve  their  virtues  un- 
impaired for  many  years. 

With  respect  to  the  time  of  gathering  the 
green  leaves,  Dr.  Withering  directs  that  they 
be  gathered  "  about  the  time  the  flowering 
stem  has  shot  up,  and  when  the  blossoms  are 
coming  forth."  However,  from  repeated 
trials  it  is  found  that  if  they  be  collected  late 
in  summer,  or  even  in  autumn,  provided  they 
receive  no  injury  from  cold  or  frost,  their 
virtues  are  probably  augmented,  and  their 
medicinal  qualities  certainly  not  impaired. 

Different  preparations.  1 .  The  substance.  2. 
The  decoction.  3.  The  infusion.  4.  The 
tincture. 

1.  The  most  simple  method  of  administer- 
ing the  foxglove  is  in  powder,  or  in  the  form 
of  pills.  Half  a  grain,  or  one  grain  of  the 
substance,  is  a  sufficient  quantity  for  a  patient 
to  begin  with.     The  pulverized  seeds  are,  on 


many  accounts,  preferable  to  the  leaves. 
"  In  them  the  whole  virtues  of  the  plant  are 
concentrated." 

2.  There  are  many  persons  of  peculiar  ha- 
bits of  body,  who  are  incapable  of  taking 
medicine  in  the  form  of  pills.  They  almost 
immediately  induce  in  them  nausea  and  vo- 
miting. In  such  cases  liquid  medicines  are 
preferable:  they  can  generally  be  retained  in 
the  stomach  with  great  facility.  A  decoction 
of  the  digitalis,  made  according  to  the  fol- 
lowing formula,  is  exhibited  with  much  ad- 
vantage : — On  two  drams  of  the  dried  leaves 
of  foxglove  pour  two  quarts  and  a  pint  of 
water,  and  boil  down  the  contents  to  two 
quarts.,  Half  an  ounce  of  this  can  be  taken 
two,  three  or  four  times  a  day. 

3.  A  slight  decoction  is  injurious  to  many- 
plants  not  more  volatile  than  digitalis :  a 
lengthy  and  violent  decoction  will  certainly 
dissipate  the  virtues  of  this  valuable  article 
of  the  materia  medica.  Dr.  Withering  and 
others  consequently  preferred  the  infusion. 
The  method  of  preparing  it,  as  Dr.  Wither- 
ing directs,  is  as  follows:- — Let  one  dram  of 
the  dried  leaves  be  infused  for  four  hours  in 


9 

half  a  pint  of  boiling  water;  add  to  the 
strained  liquor  half  an  ounce  of  any  spirituous* 
water:  an  ounce  of  this  to  be  given  twice  a 
day  to  an  adult. 

For  the  purpose  of  bringing  the  system 
gradually  under  the  influence  of  digitalis, 
the  following  is,  perhaps,  the  most  judicious 
formula : — On  one  dram  of  the  powdered 
leaves  pour  a  quart  of  boiling  water,  and  let 
it  stand  for  forty-eight  hours. 

One  ounce  of  the  dried  leaves  is  equal  to 
four  of  the  green,  for  the  purpose  of  either 
decoction  or  tincture. 

4.  The  Tincture. 

Another  mode  of  exhibiting  foxglove  is  by 
making  a  saturated  tincture.  Dr.  Darwin 
gives  it  the  preference,  and  lays  down  the 
following  rule : — "  Put  two  ounces  of  purple 
foxglove,  digitalis  purpurea,  nicely  dried  and 
coarsely  powdered,  into  a  mixture  of  four 
ounces  of  rectified  spirit  of  wine  and  four 
ounces  of  water;  let  the  mixture  stand  by  the 
lire-side  twenty-four  hours,  frequently  chak- 
ing  the  bottle,  and  thus  making  a  saturated 


tincture  of  digitalis;  which  must  be  poured 
from  the  sediment  and  passed  through  filtering 
paper.  Thirty  drops  of  this  tincture  is  di~ 
rected  to  be  put  into  an  ounce  of  mint  water 
for  a  draught  to  be  taken  twice  or  thrice  a 
day,  till  it  reduces  the  anasarca  of  the  limbs, 
or  removes  the  difficulty  of  breathing  in  hy- 
drothorax,  or  till  it  induces  sickness." 

The  object  of  this  preparation  is  to  impart 
as  much  of  the  active  parts  of  the  leaf  as  the 
spirit  is  capable  of  taking  up  and  retaining  in 
solution.  If  digestion  be  continued  a  week 
or  more,  a  very  important  object  is  gained; 
half  the  quantity  of  leaf  being  sufficient,  and 
a  larger  quantity  of  the  tincture  of  equal  effi- 
cacy is  procured.  If  the  digestion  be  con- 
ducted in  a  cool  temperature,  it  is  less  liable 
to  variation:  it  becomes  more  uniform  and 
permanent  in  different  temperatures.  The  fol- 
lowing formula,  agreeable  to  the  above  direc- 
tions, is  a  very  valuable  one,  and  has  been 
proposed  as  a  standard  for  universal  use. 

Recipe, 
Folior.  digit,  purpur.  recent,  exsiccat  unc.  i* 
Sps.  vin.  unc.  viii.  M. 
Digere  leni  calore  per  dies  septem* 


iOi!-— Recipe, 

Folior.  digit,  purpur,  recent,  unc.  ii. 
Sps.  vin.  rect.  unc.  v.  M. 
Digere  dies  septem  leni  calore. 


Mode  of  Exhibition, 

Physicians  differ  in  ©pinion  respecting  the 
method  of  exhibiting  the  digitalis  purpurea. 
Some  prefer  its  substance  in  powder  or  in  pill ; 
others  declare  that  its  virtues  are  extracted, 
and  that  it  operates  with  much  greater  effi- 
cacy in  decoction  or  in  tincture. 

It  is  said  that  the  powder  more  speedily 
nauseates,  and  more  readily  increases  the  dis- 
charge from  the  kidneys  or  intestines;  and 
therefore  that  it  is  not  so  serviceable  in  pul- 
monic complaints.  As  the  principal  object, 
by  exhibiting  this  medicine,  is  to  diminish 
vascular  action;  and  as  this  end  can  be  ac- 
complished by  either  the  tincture  or  the 
powder,  any  disputation  about  which  of  these 
two  ought  to  be  employed  is  unnecessary. 
Perhaps  it  is  agreeable  to  truth  and  matter  of 
fact  to  state,  that  there  is  no  difference  in  the 
effect  produced  on  the  system  by  different  pre- 


112 

parations  of  this  remedy,  provided  the  dose  be 
in  all  cases  exactly  the  same. 

It  is  not  possible  at  all  times  to  determine 
with  precision  the  exact  quantity  of  digitalis 
contained  in  a  given  quantity  of  liquid.  At 
the  time  of  preparing  a  decoction  or  infusion, 
many  accidents  and  circumstances  may  occur 
to  render  it  doubtful  how  much  of  the  ac- 
tive virtues  of  the  plant  may  be  present  in  a 
given  dose. 

It  is  a  desideratum  in  medicine  to  have  a 
preparation  which  may  serve  as  a  general 
standard,  possessing  its  virtues  unimpaired  at 
all  times  and  in  all  places.  A  saturated  tinc- 
ture can  best  answer  this  intention. 

That  sensible  organ  the  stomach,  through 
the  agency  of  which  the  action  of  medicines 
is  conveyed  throughout  the  body,  in  a  great 
degree,  becomes  insensible  to  their  operations, 
after  it  has  been  accustomed  to  them  for  some 
time.  An  augmentation  of  the  dose  becomes 
necessary  to  produce  the  same  effect.  Very 
irritable  stomachs  are  unable  to  retain  a  full 
dose  of  digitalis.  This  observation  holds  good 
with*  respect  to  many  other  active  remedies, 
such  as  opium,  cicuta,  the  squills,  and  hy? 


13 

drargyrum :  hence  the  necessity  and  advan- 
tage of  gradually  augmenting  the  dose  of 
active  remedies  in  the  treatment  of  obstinate 
chronic  diseases. 

The  following  method,  if  adhered  to,  is 
found  to  be  a  valuable  practical  rule : — Begin 
with  adults  in  doses  of  ten  drops  of  the  tinc- 
ture, or  half  a  grain  of  the  powder,  or  one 
table  spoonful  of  either  the  decoction  or  in- 
fusion, repeated  three  times  a  day;  gradually 
enlarging  the  dose,  if  no  disagreeable  symp- 
toms ensue,  as  the  exigency  of  the  case  may 
require.  If  nausea,  vertigo,  or  great  irregu- 
larity of  pulse  supervene,  the  doses  must  be 
diminished,  or  totally  omitted  for  a  time.  In 
children  the  medicine  should  be  lessened  in 
quantity  in  proportion  to  their  ages.  By  this 
manner  of  exhibition  the  weakest  constitu- 
tion and  the  most  irritable  habit  of  body  may 
be  sufficiently  charged  with  the  influence  of 
the  purple  foxglove. 

Modus  operandi. 

Some  physicians  imagine  that  the  good  ef- 
fects of  foxglove  result  from  its  power  of  di- 


14 

minishing  secretion  and  promoting  absorp- 
tion. But  it  may  be  objected  in  reply,  that 
foxglove  proves  very  serviceable  in  cases 
where  there  is  no  increase  of  pus  or  mucus,  as, 
for  instance,  in  dry  coughs  and  dyspnoea. 

Digitalis  does  not  always  prove  effectual  by 
reducing  the  frequency  of  the  pulse :  several 
instances  have  been  remarked  where  the  pul- 
sations appeared  to  be  somewhat  increased, 
and  yet  a  complete  cure  effected. 

The  manner  in  which  digitalis  operates  is 
explained  by  Dr.  Darwin  in  the  following 
words: — "  From  the  great  stimulus  of  this 
medicine  the  stomach  is  rendered  torpid  with 
consequent  sickness,  which  continues  for 
many  hours  and  even  days,  owing  to  the 
great  exhaustion  of  its  sensorial  power  of  ir- 
ritation :  and  the  action  of  the  heart  and  arte- 
ries becomes  feeble  from  the  deficient  excite- 
ment of  the  sensorial  power  of  association: 
and,  lastly,  the  absorbents  of  the  cellular  mem- 
brane act  more  violently  in  consequence  of 
the  accumulation  of  the  sensorial  power  of 
association  of  the  torpid  heart  and  arteries. " 
When  a  small  quantity  of  foxglove  is  at  first 
taken,  and  the  dose  gradually  augmented, 


15 

the  patient,  feels  the  following  effects  and 
changes . — Torpor  and  heaviness  of  the  whole 
body,  languor  and  indifference  to  voluntary- 
exertion,  slight  nausea,  vertigo,  pain  and  a 
sense  of  lightness  in  the  head :  then,  if  the 
medicine  be  persisted  in,  comes  on  extreme 
nausea  and  vomiting;  objects  appear  of  a 
green  colour.  If  the  urine  be  sensibly  in- 
creased in  quantity,  these  symptoms  are  not 
so  violent,  or  a  longer  space  of  time  is  required 
to  produce  the  same  effects. 

The  pulse  becomes  affected  in  a  remark- 
able manner;  the  heart  and  arteries  beat  less 
frequent,  or  with  great  irregularity;  while 
feeling  the  pulse  of  a  patient,  it  sometimes 
appears  as  if  the  action  of  the  heart  was  for  a 
moment  suspended;  general  irritation  is  al- 
layed ;  the  actions  of  the  absorbent  vessels  are 
increased;  the  lymphatics  are  placed  in  a 
state  of  carrying  on  healthy  absorption,  and 
continue  so  till  they  regain  their  former  habit 
of  action. 

If  forty  drops  of  the  tincture,  or  two  grains 
of  the  substance  of  digitalis,  be  thrown  into 
some  irritable  stomachs,  it  will  speedily  pro- 
duce nausea  and   vomiting,   which  evinces 


16 

the  propriety  of  beginning  with  small  doses, 
as  already  mentioned,  and  of  making  a  gra-- 
dual  increase^  that  the  stomach  may  be  ha- 
bituated to  their  operation.  By  these  precau- 
tions the  effects  of  foxglove  are  observed  be- 
fore they  become  excessive. 

The  reduction  of  vascular  action  without 
inducing  previous  excitement,  is  peculiar  to 
the  digitalis  purpurea. 

Correctors  of  the  deleterious  effects  of  Digitalis, 

As  digitalis  diminishes  the  power  and  acti- 
vity of  the  arterial  system,  it  is  of  importance 
that  some  substance  should  be  given  with  it, 
which,  while  it  permits  the  digitalis  to  pro- 
duce this  effect,  might  also  prevent  that  ex- 
treme languor  which  often  proceeds  so  far  as 
to  sink  the  patient.  Some  physicians  have 
thought  thatSeneka  snake-root  will  frequently 
serve  this  purpose;  and  that  calomel,  com- 
bined with  the  powder  of  digitalis,  is  also  a 
corrector  of  it.  Steel  will  also  aid  the  system 
in  such  cases;  for  if  wine  and  the  more  dif- 
fusible stimuli,  or  the  tonics  joined  with 
much  aroma,  should  be  given,  then  too  much 


17 

excitement  would  be  produced  after  the  ex^ 
citability  had  been  accumulated  by  the  torpor 
and  languor  produced  by  the  digitalis.  Steel* 
we  know,  is  a  pure  tonic,  and  only  produces 
stimulant  effects  in  a  moderate  manner : 
whenever,  therefore,  the  stomach  is  first  af- 
fected, the  nausea  will  be  carried  off  by  the 
suspension  of  the  digitalis,  and  the  admini- 
stration of  porter  or  some  bitters.  When  the 
pulse  is  affected  the  stomach  seldom  partakes ; 
and  then  the  pulse  may  be  raised  by  giving 
some  steel,  or  tincture  of  bark,  although  the 
digitalis  be  persisted  in.  If  vertigo  be  pro- 
duced, the  foxglove  must  absolutely  be  de- 
sisted from ;  and  then  steel  and  the  warm  bath 
are  the  proper  correctives. 

Diseases  hi  which  Digitalis  proves  of  benefit. 

1.  In  inflammatory  diseases  attended  with 
local  congestion.  2.  In  consumption.  3.  In 
dropsy. 

1.  In  the  first  class  of  diseases,  the  foxglove 
is  serviceable  upon  the  principle  of  its  operat- 
ing quickly  and  powerfully  upon  the  arterial 
system,  and  thereby  arresting  the  rapid  pro- 


gress  of  the  inflammatory  symptoms.  Croup* 
pleurisy,  peripneumonia,  chronic  cough,  ca- 
tarrh, mania,  and  hooping-cough,  are  cured 
by  the  use  of  digitalis, 

Case  of  chronic  cough* 

A.  L.  aged  38,  has  been  troubled  for  eigh- 
teen months  past  with  a  continued  cough.  At 
present  breathes  with  difficulty:  voice  hoarse; 
coughs  violently  at  times;  expectorates  mu- 
cus; sleeps  ill  for  the  most  part;  pulse  96, 
full  and  strong. 

December  28th.  Took  half  a  grain  of  di^ 
gitalis,  and  the  same  quantity  of  opium  made 
into  a  pill,  three  times  a  day. 

30th.  Pulse  nearly  the  same ;  sleeps  rather 
better;  bowels  costive.  Took  five  grains  of  ca- 
lomel with  each  pill  until  a  stool  was  procured. 

January  1st.  Is  better  in  every  respect; 
urine  increased  in  quantity.  The  digitalis  is 
increased  to  one  grain. 

3d.  Coughs  more;  pulse  90;  complains  of 
weakness  in  the  joints.  The  pills  are  omitted,, 
and  half  a  grain  of  digitalis  and  one  grain  of 
opium  are  taken  morning  and  evening. 


19 

5  th.  Is  better  in  every  respect;  pulse  86; 
expectorates  less. 

7th,  9th,  11th,  14th,  18th.  Gets  better; 
pulse  slow ;  urine  increased  in  quantity. 

20th.  Complains  of  debility.  Was  put  on 
the  use  of  tonic  medicines,  and  has  since 
recovered. 

2.  Consumption.  The  foxglove  was  for- 
merly used  with  advantage  in  epilepsy,  and 
in  scrophula,  taken  either  internally,  or  ap- 
plied externally  in  the  form  of  ointment.  It 
has  long  since  been  recommended  for  con« 
sumption  also;  but  from  want  of  knowledge 
of  its  properties,  and  mode  of  exhibition,  it 
was  employed  with  such  caution  that  the  sick 
were  left  without  relief  and  without  hope. 

In  phthisis  the  foxglove  acts  on  the  system 
and  corrects  its  morbid  phenomena,  by  pro- 
ducing absorption — allaying  the  cough  and 
the  augmented  irritation  of  the  lungs — and 
diminishing  the  action  of  the  heart  and  ar- 
teries. 

Case. — Deborah  G — >  aged  1 8,  of  a  delicate 
habit  of  body,  upon  making  an  excursion 
into  the  country  was  taken  with  chills,  suc- 
ceeded by  hot  fits,  slight  cough,  impaired 


20 

appetite,  and  a  stoppage  of  the  menstrual  dis? 
charge.  No  medical  aid  being  applied  for 
four  months,  the  symptoms  increased  in  vio- 
lence, and  daily  grew  more  alarming. 

November  8th.  Coughs  and  expectorates 
considerably;  sleeps  little;  has  pain  in  the  left 
side,  and  difficulty  of  deglutition;  exacerba-^ 
lions  of  fever  morning  and  evening,  and  col- 
liquative sweats.  Took  of  the  tincture  of  di- 
gitalis ten  drops  three  times  a  day. 

9th,  10th,  11th.  No  sensible  effect  pro- 
duced by  the  digitalis;  pulse  88. 

12th.  Urine  increased ;  cough  and  expec-? 
toration  as  before. 

13th.  The  tincture  increased  to  twelve 
drops. 

14th.  Expectorates  Jess.  Digitalis  taken 
four  times  a  day. 

1.5th.  Is  delirious  at  times;  expectorates  lit- 
tle; coughs  more.     Medicine  omitted. 

18th,  19th.  Cough  less;  sleep  and  appetite 
better;  expectorates  freely. 

In  phthisis  pulmonalis  it  has  been  observed 
in  the  New-York  hospital,  that  it  was  an  un- 
favourable symptom  when  digitalis  did  not 
lessen  the  frequency  of  the  pulse ;  and  in  such 


21 

cases  the  patient  generally  showed  after  death 
tubercles  in  the  lungs. 

3.  Dropsy,  The  indications  of  cure  in  this 
complaint  are,  1st.  To  evacuate  the  supera- 
bundant fluid:  2d.  To  prevent  its  farther 
accumulation.  To  obviate  the  first  indication 
active  diuretics  are  employed,  in  order  to 
stimulate  the  kidneys  and  determine  the  serous 
fluid  to  those  passages. 

From  sympathy,  or  an  indissoluble  associ- 
ation between  the  heart  and  stomach,  if  nau- 
sea be  produced,  the  pulse  sinks  in  conse- 
quence. As  arterial  action  is  diminished 
absorption  begins:  hence  the  use  of  emetics 
to  produce  absorption.  By  means  of  the 
digitalis  absorption  can  be  produced  from  the 
lungs,  abdomen,  &c.  without  the  disagree- 
able intervention  of  nausea  and  vomiting. 
This  remedy  is  found  to  be  most  serviceable 
in  the  following  species  of  dropsy :  Ascites, 
anasarca  of  the  lungs,  hydrops  pericardii, 
hydrops  thoracis. 


22 


Case  of  Ascites. 

James  H ,    shipcarpenter,    of  strong 

muscular  fibre  and  plethoric  habit,  having 
exposed  himself,  in  the  month  of  September, 
to  much  rain  and  a  chilly  night  air,  was  at- 
tacked with  fever,  which  was  subdued  by  the 
usual  remedies.  A  few  days  after  apparent 
recovery  he  again  exposed  himself  to  a  very 
damp  and  cool  atmosphere. 

October  2d.  Complains  of  pain  in  the  head 
and  abdomen;  ordered  a  dose  of  calomel. 

4th.  Pain  in  the  head  better;  urine  scanty. 

6th.  Has  a  sense  of  weight,  fullness,  and 
tightness  of  the  abdomen;  great  thirst;  a  flue-? 
tuation  in  the  abdomen  perceptible. 

7  th.  Took  twelve  drops  of  the  tincture  of 
digitalis  morning  and  evening. 

3th.  No  sensible  change. 

9th  f  Much  as  before.  Took  twelve  drops 
three  times  a  day. 

10th.  Urine  increased  in  quantity;  the  dose 
augmented  to  fifteen  drops. 

11th,  12th.    No  pain;  respiration  free. 

14th.     The  abdomen  is  of  its  natural  size. 


23 


RECAPITULATION* 

1 .  Digitalis,  if  carefully  and  gradually  ex- 
hibited, may  ultimately  be  given  with  perfect 
safety  in  large  doses. 

2.  When  digitalis  is  exhibited  repeatedly, 
and  at  short  intervals,  the  strictest  caution  is 
necessary  to  prevent  the  alarming  and  even 
fatal  consequences  which  may  ensue. 

3.  When  the  system  becomes  charged,  and 
completely  under  the  influence  of  digitalis* 
it  possesses  a  power  of  arresting  the  motion 
of  the  heart  and  arteries  to  a  degree  hitherto 
thought  incompatible  with  the  existence  of 
animal  life. 

4.  Digitalis,  in  simple  inflammatory  dis- 
eases, may  supersede  the  necessity  of  repeated 
bleeding  and  purging. 

5 .  Digitalis  is  an  excellent  remedy  in  ana- 
sarcous  affections  of  the  lungs,  and  in  cases 
where  effusion  or  inflammatory  exudation  has 
taken  place. 

6.  The  foxglove  is  a  glorious  remedy  in 
active  haemorrhage,  by  retarding  the  velocity 
of  the  circulation. 


24 

7.  In  pulmonary  consumption,  arising 
from  haemoptysis,  much  relief  is  obtained 
from  the  use  of  digitalis. 

8.  Digitalis  is  useful  in  chronic  coughs,  in 
spasmodic  asthma,  and  in  palpitations  of  the 
heart  not  depending  on  debility,  upon  the 
principle  of  diminishing  irritability. 

9.  The  criterions  by  which  we  are  to  be 
guided  in  regulating  the  doses  of  foxglove^ 
are  the  phenomena  arising  from  its  action  on 
the  stomach,  on  the  sensorium,  and  on  the 
blood-vessels. 


FINIS, 


COLUMBIA  UNIVERSITY  LIBRARY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

C2B(23»)M100 

Broker 
-.ISA   of.  di 


>n  the 


